Pertzye — Blue Cross Blue Shield of Kansas

Preferred products

• Creon
• Zenpep

Initial criteria

• 1. The requested agent is eligible for continuation of therapy AND ONE of the following:
• A. The patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days OR
• B. The patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days AND is at risk if therapy is changed
• OR
• 2. The patient has one of the following:
• A. The patient has ONE of the following:
• 1. Has a medication history of use in the past 180 days to TWO prerequisite agents OR
• 2. Has a medication history of use in the past 180 days to ONE prerequisite agent and an intolerance or hypersensitivity to ONE prerequisite agent OR
• 3. Has an intolerance or hypersensitivity to TWO prerequisite agents OR
• B. The patient has an FDA labeled contraindication to ALL prerequisite agents

Reauthorization criteria

• Continuation of therapy as described in initial criteria

Approval duration

12 months